Need help analysing my data from CPAP

[Moochetta]

Hi Everyone - Well, thanks to Georgio I was able to go into my CPAP machine and get a bunch of data. The problem is I don't know what it's telling me. Sorry to be such a "newbie"! If anyone is willing to take the time to help, I'd truly appreciate it.

Start CPAP 4.0
CPAP 9.0
Max ramp 45
AHI 1.1
AI 0.0
HI 1.1
Leak 0.32L/S
EPR - off

Help??????

Thanks,
Michele

[Arizona-Willie]

Wow!! You keep posting numbers like that and people will be throwing custard pies at you

Many struggle to get their AHI below 5.

You got great numbers. Whatever you're doing ... keep it up.

[Slinky]

Start 4 cms and Ramp 45 minutes = Your Elite starts out at 4 cms and builds up pressure in .2 cm increments to your set pressure of 9 cms over a 45 minute period (the length of time estimated for you to fall asleep).

AHI 1.1 = you have a combination of 1.1 apneas/hypopneas per hour you slept
AI 0.0 = you had no apneas all night long
HI 1.1 = the number of hypopneas per hour that you had

Those are GREAT numbers!!! An AHI of less that 5 is considered normal sleep. Its most desirable to have less apneas than hypopneas so again you've done great!

Your leak rate is a bit high but w/that AHI data and if you're feeling good in the morning and thru out the day - so what? Fergeddit.

EPR = expiration pressure relief. It wasn't turned on by the DME or ordered turned on by your sleep doctor and obviously, given the rest of your data, you don't need it. EPR can be set to give 1 to 3 cms of pressure relief on exhalation, i.e. set at 3 your Elite would provide 6 cms of pressure on exhalation and 9 cms on inhalation and would reduce the reported pressure since you inhale half the night and exhale half the night. As I said, obviously you don't need EPR turned on at any setting.

Of course, the true proof of the pudding is more like one full week's average data AND how you feel in the morning and during the day. One night does not always the entire story tell. We don't breathe or sleep exactly the same each night.

[Georgio]

You have verified that your machine is set to your titrated pressure of 9.

Does anyone think that a ramp start of 6.5 would provide a less noticable change up to 9? I was told 4 is really low. I go from 6.5 to around 8.

You could check into if your EPR is prescribed to be turned off. I think pressure relief on exhalation makes CPAP much more tolerable and that could help with your perception of pressure.

Hope you see more improvement.

Georgio

[Hawthorne]

I agree with Georgia. A ramp setting of 4 is too low for almost everyone. It takes too long to get from 4 to your titrated pressure ( the pressure needed to keep your airway fully open). I think you will get better benefit from your machine if you start ramp at 6 or 6.5. -- maybe even 7 in your case. You need to experiement for a few days at each setting to see how you feel and which ramp setting is tolerable (allows you to get to sleep easily). The higher you set you ramp, the closer it is to your therapy pressure - the sooner cpap is beneficial to you. There may come a time when you won't use ramp at all.

[Slinky]

Say what, you guys? If the comfort and data continue as is, Moochetta would be a fool to change anything!! IF or when Moochetta has trouble GETTING to sleep THEN would be the time to set the starting Ramp pressure higher, shorten the Ramp time or turn Ramp off entirely.

Georgio is right, most of us can NOT breathe comfortably at 4 cms and 45 minutes at .2 cm increments would be too little too slow for the vast majority of us. But Moochetta didn't mention any problems getting to sleep.

[Hawthorne]

You are right Slinky. Point taken. However, in another thread, she speaks of having chest pains. Could that be from having too low a ramp setting and not getting enough pressure for 45 minutes?

[Slinky]

Aha! I had no knowledge of ANY problems Moochetta might be having except not understanding the data. I really don't have any idea of possible causes of chest pain so I'm way outta my league on that subject.

[ozij]

That leak rate.... on a Resmed.... without knowing the mask Moocheta uses nor what the machine is told...

I'd wait before throwing my cap in the air...


O.

[Slinky]

Not to argue, but to learn, Ozij, WHY?

0.40 L/s = 24 L/M

0.32 L/s = somewhat less than 24 L/M which the Elite is more than able to compensate for. A too high leak rate should cause an artificially HIGH AHI, shouldn't it?? At least that would be my understanding. I fail to see where a too high leak rate could cause an artifically LOW AHI.

Moochetta, the cause for confusion here is because unlike the Respironics and, I believe, other xPAP manufacturers, Resmed has a Mask Selection option in the internal software. It is programed to automatically DEDUCT the allowed vent rate for each of their masks at their correct mask selection at the set pressure from the reported leak rate. If using a non-Resmed mask the Mask Selection should correctly be set to the Standard selection. The Resmed xPAP then automatically deducts 0.4 L/s (24 L/M) from the REPORTED leak rate.

W/the Respironics, for instance, one has to determine the allowed vent rate at their set pressure from the table in their mask's literature and SUBTRACT that from the REPORTED leak rate to know their true 90th percentile leak rate.

The Resmeds report the 95th percentile leak rate rather than the 90th percentile. That 95th or 90th percentile leak rate is the leak rate AT OR BELOW which you spent 95 or 90 percent of the night.

[ozij]

Not to argue, but to learn, Ozij, WHY?

0.40 L/s = 24 L/M

0.32 L/s = somewhat less than 24 L/M which the Elite is more than able to compensate for.

And if that 0.32 L/s were to be the leak above the mask's expected leak? According to its manual, the Breeze's expected leak rate at 9 cms h2o would be about 22 L/M. If Resmed subtracts, then Moochetta's leak reported leak should be 0, or a tiny bit more.

A too high leak rate should cause an artificially HIGH AHI, shouldn't it?? At least that would be my understanding. I fail to see where a too high leak rate could cause an artifically LOW AHI.

Mouthleaks can cause the AHI to be unidentifiable. And under those conditions, the low AHI reported is actually misleading.


O.

[Slinky]

... And if that 0.32 L/s were to be the leak above the mask's expected leak? According to its manual, the Breeze's expected leak rate at 9 cms h2o would be about 22 L/M. If Resmed subtracts, then Moochetta's leak reported leak should be 0, or a tiny bit more.

A too high leak rate should cause an artificially HIGH AHI, shouldn't it?? At least that would be my understanding. I fail to see where a too high leak rate could cause an artifically LOW AHI.

Mouthleaks can cause the AHI to be unidentifiable. And under those conditions, the low AHI reported is actually misleading.

Well, yes to the first, but I didn't say her leak rate wasn't high, just that w/that AHC I wouldn't be too concerned about leaks just yet since this was only one night's data.

Mouth leaks like jaw dropped open? Or the "lip flutters" too? I'm having trouble wrapping this ole brain around that one, Ozij. But I do know that you have a much better grasp of CPAP therapy than I do!!!

[Moochetta]

Wow!! You guys are all amazing. And I must admit my brain is swirling after reading all your posts. I'm so new to all this stuff. By the way, I always fall asleep easily, so I have no problem with my ramp setting. On the regular LCD display I have my ramp set to 10 minutes.... so I don't understand the 45 minute internal setting...

I had a two-fold reason for wanting all of your wonderful input. One is to begin to understand what all these numbers mean and TWO is to try to figure out why I'm having such physical problems since starting CPAP. I stopped smoking on July 13th and started CPAP on August 7th. I felt great! My brain was working again, but I must admit although my brain was working, I felt like I was walking around in kind of a fog. My sleep clinician had said I'd be sharp as a tack in the mornings. I wasn't (I still am not). Then came the dreaded August 19th. Horrible chest pains and shortness of breath that landed me in the emergency room. Nothing was wrong after all the tests. On August 21st I had my appointment with the DME to get my official sleep clinic results. On that day I switched from a mask to the Breeze with nasal pillows. I continued to have shortness of breath which would then lead to a sort of hyperventilation which would then result in kind of a panic attack. I still was waking up in a fog, but my brain was great. The shortness of breath was getting better, hence so were the panic attacks (which I'd never had before in my life!)... then came the second dreaded day of September 18th (exactly one month from the first time) when I awoke again with severe chest pains, feelings of bruised lungs, shortness of breath, etc. Also my ribcabe was hurting and it hurt to press on the area of my chest under my clavicles. I did not go to the ER again. The pain lasted for 2 days and I'm now fine except for severe shortness of breath. I also feel like a bowling ball is resting on my diaphragm.

What it feels like is that my lungs are getting overworked and stretched to capacity....they feel "bruised", but this is the next day after CPAP. I sleep fine through the night. There are so many possibilities of what could be wrong. It could be pericarditis, it could be getting used to the machine, it could be that I have a very small hiatal hernia. So here I am asking myself... do I need a cardiologist? A pulmonary doc? A gastro doc? Yikes!

And yet... through all of this physical malaise...I feel physically awful...but my brain is back.

Thanks to everyone,
Michele

[ozij]

I think you should have all medicine possibilities checked out, and the following suggestion is not to be seen as implying you should leave that track. If I had to be, I'd bet on that hernia - and I know some problems in your stomach can be felt in you upper back.

On the regular LCD display I have my ramp set to 10 minutes.... so I don't understand the 45 minute internal setting...

However, I'm also wondering if you're not having a machine malfunction which is causeing it to supply far more pressure than you need. Pain requiring morphine does not sound to me like it could be caused by too much pressure - however, the following symptoms: feeling bruise in your lungs (and or chest and or upper back), and waking up breathless do.

On the regular LCD display I have my ramp set to 10 minutes.... so I don't understand the 45 minute internal setting...

Are you sure you have an Elite? Could it be a Vantage, with 9 as it minimum and the max. at 20?
Any chance you could have a replacement machine for a month, just to rule out a machine malfunction?


O.

[ozij]

Well, yes to the first, but I didn't say her leak rate wasn't high, just that w/that AHC I wouldn't be too concerned about leaks just yet since this was only one night's data.

I didn't say her AHI rate wasn't low, just that w/that leak rate I wouldn't be too overjoyed about AHI just yet since this was only one night's data.

And I don't know enough to answer you about mouthleaks vs. lip flutters. I'm wary of them both...

O.